Contacts
Office of Emergency Medical Services - Ambulance Services
The Details of Report an unprotected exposure - EMS responders
What you need for Report an unprotected exposure - EMS responders
- On the form, check all boxes that apply:
- The exposure route to you of a patient’s blood or bodily fluid(s)
- The type of the patient’s bodily fluid(s) to which you were exposed
- Body substance isolation precautions you used (even if they were breached)
- Post incident cleaning you performed
- If you checked any “Other” box(es), explain in the space(s) provided
- In the blank narrative sections, explain the exposure and any treatment you've obtained. Use additional blank sheets, if necessary, and staple them to the form. The more accurately you explain the circumstances, the easier it will be for the facility personnel to evaluate your exposure.
- EMT’s must also leave a copy of the ambulance trip record at the receiving facility.
- Each individual should fill out their own forms.
How to report Report an unprotected exposure - EMS responders
- Download the Ambulance Unprotected Exposure Form
- Complete out the form
- Submit your form(s) to the health care facility that received the patient. Do this upon patient arrival or within 24 hours
- DON'T send the original form or a copy to the Department of Public Health
More info for Report an unprotected exposure - EMS responders
- Don't delay transportation or treatment of the patient(s) to complete the form(s).
- Make a copy for your own records and/or for your designated infection control officer, under your employer’s policies and procedures.
Contact for Report an unprotected exposure - EMS responders
Address
67 Forest St., Marlborough, MA 01752